British journal of anaesthesia
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NHS Blood and Transplant (NHSBT) was established in 2005 as a Special Health Authority when the National Blood Authority and UK Transplant merged. This helped to bring tissue banking and organ transplantation services under one umbrella organization. This merger means that ~!95% of all deceased donors (whether tissue, organ or both) are now facilitated by one organization. ⋯ Annually there are ~450 multi-tissue donors and 2500 eye donors in the UK, resulting in many thousands of transplants, including 3564 cornea transplants in 2010-2011. The separation of tissue- and organ-specific donors is largely artificial, and while organ transplantation can be life-saving, tissue transplantation can also have a dramatic effect on a patient's quality of life. It is hoped that all donors, both organ and tissue, will be recognized for the gift they make to society after their death.
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'Cardiomyopathy' (CM) is defined by the World Health Organization as 'a disease of the myocardium associated with cardiac dysfunction'. In a child, it is associated with a significant risk for anaesthesia. In addition, cardiac arrest under anaesthesia has been attributed to an undiagnosed CM. ⋯ This review describes the different forms of the disease in terms of pathology, aetiology, and clinical presentation. Dilated, hypertrophic, and restrictive CM are the most common forms. We examine recent advances in therapy, including the management of severe end-stage disease, while highlighting the specific anaesthetic considerations for children with each type of CM.
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The main factor limiting organ donation is the availability of suitable donors and organs. Currently, most transplants follow multiple organ retrieval from heartbeating brain-dead organ donors. However, brain death is often associated with marked physiological instability, which, if not managed, can lead to deterioration in organ function before retrieval. ⋯ Despite increasing consensus over donor management protocols, many of their components have not yet been subjected to controlled evaluation. Hence the optimal combinations of treatment goals, monitoring, and specific therapies have not yet been fully defined. More research into the component techniques is needed.
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Deceased donation in the UK relies upon family consent. Approaching a family at the tragic time of a loved one's death requires significant emotional resilience from staff. ⋯ This paper seeks to provide an overview of some of key issues relating to death, death rituals, faith, and how these may impact upon organ donation. This should be of benefit to staff dealing closely with recently bereaved families and who will be requesting organ donation from them.
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Randomized Controlled Trial
Simulated evaluation of a non-Luer safety connector system for use in neuraxial procedures.
Spinal syringes, needles, and other devices with connectors that will not also connect with Luer devices could substantially reduce wrong-route drug administration errors. This study aimed to evaluate a newly designed non-Luer safety connector system for neuraxial procedures in terms of clinical acceptability and cross-connectivity with conventional Luer devices. ⋯ Our study demonstrated that study clinicians found the safety system to be acceptable with minimal impact on technique in a simulated-use setting. The non-Luer system also appeared to decrease the risk of administration of i.v. medications into the intrathecal space. Further modifications will be required to completely eliminate the risk of administering intrathecal medication i.v. and evaluation in a clinical setting will help determine the true impact of this non-Luer system on patient safety.